Cesarean section . lls for careful investigation. The importance of early recognition isconsiderable, because in all but slight cases delivery through the pelvis OTHER PELVIC INDICATIONS 47 is impossible and pubiotomy is out of the question, owing to the ankylosisof the sacro-iliac joint. In marked degrees of contraction either cesareansection or craniotomy is necessary for delivery, and the former is in-dicated whenever the deformity is discovered during pregnancy or at aperiod of labor which does not contraindicate abdominal delivery. Transversely Contracted, or Robert Pelvis.—This form of c
Cesarean section . lls for careful investigation. The importance of early recognition isconsiderable, because in all but slight cases delivery through the pelvis OTHER PELVIC INDICATIONS 47 is impossible and pubiotomy is out of the question, owing to the ankylosisof the sacro-iliac joint. In marked degrees of contraction either cesareansection or craniotomy is necessary for delivery, and the former is in-dicated whenever the deformity is discovered during pregnancy or at aperiod of labor which does not contraindicate abdominal delivery. Transversely Contracted, or Robert Pelvis.—This form of con-tracted pelvis is seen when the sacral alae on both sides are imperfectlydeveloped. Examination shows that all the transverse measurementsare markedly shortened, while the anteroposterior measurements arepractically unchanged. It is an exceedingly rare form of contractedpelvis, but in all reported cases the transverse narrowing has been sogreat as to render the birth of a living child impossible. Cesarean sec-. FiG. 24.—Pelvis Transversely Contracted. tion at the time of election, if the condition is discovered as it should bebefore the onset of labor, is the only rational treatment. Osteomalacic Pelvis.—Osteomalacia is a very rare disease in thiscountry, but occurs sufficiently often so that every obstetrician of largehospital experience is liable to meet with an occasional case. Since thevertebral column and pelvis are the portions of the skeleton most af-fected, it has a special importance obstetrically, particularly since thepelvic change increases in repeated pregnancies, so that instead of laborbecoming easier it may eventually become impossible and require cesareansection for delivery. The history of these patients is usually quite characteristic and aidsgreatly in the diagnosis of the condition. The parturient woman, usuallya multipara, complains of muscular symptoms, generally involving theiliopsoas muscles, associated with rheumatoid pains. The same symptoms
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